Inspection on 20/11/07 for The Ridings

This inspection was carried out on 20th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Ridings 08/10/09

The Ridings 06/11/08

The Ridings 29/05/07

The Ridings 16/01/07

The Ridings 30/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Ridings Farnborough Road Castle Vale Birmingham B35 7JG Lead Inspector Mrs Amanda Hennessy Key Unannounced Inspection 20th November 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Ridings Address Farnborough Road Castle Vale Birmingham B35 7JG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 748 8770 0121 747 0163 theridings@dukerieshealthcare.co.uk Dukeries Healthcare vacant post Care Home 82 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (62) of places The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate up to 82 people in total within the following categories: A maximum of 20 people under the age of 65 years of age can be accommodated to include 11 people also receiving nursing care. In addition 5 of the 20 beds can be used for either care (maximum 25 care only) or care with nursing (maximum 16 nursing care). A maximum number of 62 people can be accommodated over the age of 65 years for reasons of dementia to include 34 persons also receiving nursing care. In addition 5 of the 62 beds can be used for either care (maximum of 23 care only) or care with nursing (maximum 39 nursing care) One named resident over the age of 65 years can be accommodated on the nursing unit for people under the age of 65. 29th May 2007 2. Date of last inspection Brief Description of the Service: The Ridings is a large care home in Castle Vale that has been built by the Dukeries organisation It is registered to provide a service for up to 20 younger adults with a dementia of whom 11 can receive nursing care and up to 62 older adults with a dementia of whom 34 can receive nursing care. There are two residential units called Aintree and Doncaster, two units which provide nursing care called Cheltenham and Ascot and two units for younger adults known as Champion Crescent. The residents’ rooms all have single en-suite facilities and are spread across six independent units. All units have their own dining room and lounge areas and bathing facilities. There is a fully adapted bathroom and a shower room to meet a wide range of movement and with additional toilets available for wheelchair users close by residents’ rooms. All areas of the home including the first and second floors are accessible by a large passenger lift. There are enclosed gardens for residents on all units, however at present much of the plant life needs to mature. There is limited car parking at the front of the building with additional car parking also behind the home. The home is close by many bus and rail routes in and out of the city and within close proximity of local shops and other community facilities such as a retail park. Fees were not seen within the service user guide during this inspection. Contact should be made with the Home Manager for up to date information about the fees that the home charges. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection undertaken by two Inspectors over three days. The inspection included a review of information supplied by the Home Manager called “`An annual Assurance Assessment” which provides detailed information about the establishment, policies and procedures at the home, information about the homes residents, personnel and information about other health professionals who support the residents at the home. Before the inspection nineteen relatives/ residents completed a survey form known as “have your say about…” telling us about their experiences of life at the home. Four staff also returned a “Have your say” survey telling about their experience of working at the home. During the inspection the inspectors followed the experiences of living at the home for ten residents, including looking at their care records, conversations with them, viewing their rooms and talking to their relatives whenever possible. This process is known as case tracking. The inspectors were able to meet with and talk with other residents, relatives and staff. Who told us in their opinion of what it is like to live in the home. A tour of the residents’ rooms and communal and service areas was completed and records about safety of equipment and the building were checked. The eighteen of the previous nineteen requirements have been addressed; two new requirements were made as a result of this inspection. What the service does well: The home provides care for people with dementia. The Home Manager has expressed an ambition that the home will become a “centre of excellence for dementia care”. Residents have their healthcare needs met and medicines are appropriately administered to residents. The majority of relatives who returned surveys to the Commission for Social care Inspection expressed their satisfaction with the home and the care that is provided: The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 6 “ Care for my mom and provide love and care she needs, I admire their skills and thank them for doing all that they can to look after my mom and others as well as they do”. “Mom has been in this care home for over 12 months, she is happy and safe and that is enough to put relatives mind at rest. She trusts and recognises the staff and lives her life to the best of her ability whilst suffering from dementia. Staff were more positive about the training increasing their confidence that they know and understand the needs of residents at the home. The majority of relatives praised permanent staff at the home. One expressed her thanks to staff : “ I would like to say thank you for the great care and attention the team has given us” What has improved since the last inspection? The new manager has made considerable improvements since he has been at the home. It was noticeable that the home now has effective leadership which is giving all staff direction and gives greater assurance that residents receive improved care. New care records have been introduced that focus on the residents general needs rather than just their medical/physical needs. The recently introduced care plans help staff to gather important information about the person including their choices and preferences of daily life residents enabling the care plans to be individualised positive about the care. There has been some improvement to the environment of the home. The home is generally much cleaner and with the thoughtful use of colour and the addition of wall hanging and pictures there is improved visual stimulation which is so important for people with dementia. There has been a doubling of domestic and laundry hours to ensure that the home is clean and that residents have their clothes returned from the laundry more quickly. There is greater confidence that people are being listened. Complaints are investigated thoroughly and appropriately. People who do not want to make a formal complaint there is a “suggestions box” and regular home manager surgeries where any issues can be discussed. Staff have greater insight of what constituents abuse and when allegations are made appropriate actions are undertaken to safeguard the homes residents. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 5 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be assured that the home will explore their needs and choices and understand their illness and how it will affect them giving assurance that their needs will be met. EVIDENCE: People are assessed prior to their admission to the home, by an appropriately trained member of staff. All pre-admission assessments include both the psychological and physical needs of the person and also identify their self care abilities and when they may require assistance. A review of peoples’ care records showed that the assessments of need was mostly completed comprehensively. The home is now using the Simon’s assessment tool which is very person centred asking about the individual and their choices in daily life, however is dependent whether staff complete it which had not happened in all cases. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 10 All private residents receive a service user contract outlining their rights, terms and conditions of residency, funded residents have this information within the service user guides located in each resident room. People who returned the “have your say” surveys said that they and their families had been able to visit the home before they came to live there and were given information about the home. It was positive that staff have now had training in Alcohol related dementia and dementia care. Staff said that they feel more confident and are working hard to implement the new assessment work. “I think we work hard and we have training to help us”. The home has five beds for intermediate care within the Working Age Dementia unit. The Deputy manager said that they are reducing the number of intermediate care beds from five to three and that the long term plan will be that the Ridings no longer provide intermediate care. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides healthcare and personal care that whenever possible reflects residents’ individual needs and choices. The administration of medicines to residents is undertaken safely although the storage of medicines may compromise the safety and effectiveness of some medicines. EVIDENCE: This inspection found that care and care records were much improved and with plans in place to ensure that improvement continues, this gives greater assurance than residents receive the care that they need. Residents whose care records were reviewed all had assessments of need, although care plans had not always been developed from these identified needs. The Manager explained that the assessment of needs form part of the persons initial care plan which is usually completed prior to the persons admission to the home. Care records seen within the assessments however did not always provide sufficient detail or say how needs should be met by staff. Those people without care plans were generally found to be relatively new residents. Staff said that they have only been in a few weeks and therefore they had not planned any The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 12 care. We advised that initial care plans would be advantageous in order to meet peoples’ needs initially as they move into the home and can be used as part of their ongoing assessment. One recently admitted person on Doncaster did have a community care assessment that detailed that the lady had some challenging behaviour, but there was no care plan in place to show staff how to meet this lady’s challenging needs. It was positive though when we spoke to staff they were clearly aware of how to meet this person’s needs. The majority of care plans were up to date although those units who were using the new care planning records (Simons’ assessment tool) had the most information and demonstrated a good understanding of the needs of their residents. Good care plans are place for residents who have challenging behaviour. Care plans identified recognised triggers for challenging behaviours and provided excellent information for staff how to meet these peoples’ needs sensitively. There were some care plans in place that had not been updated to reflect changes in care for example short term problems such as those residents with chest infections or urine infections. Care plans showed evidence of consultation with the person and their family as the Simon’s assessment processes is person centred and could only have been completed with the involvement of the person being assessed. Care records generally all showed that people have regular access to health professionals such as their GP, chiropodists, opticians, dentists and have dieticians when it is requested. Some relatives said “We are informed straight away if anything is wrong no matter how small the accident or illness is” Other relatives however said that they had not been informed of a fall that their relative had sustained until they visited. Care records of another resident living on Ascot unit also identified that her son had not been happy that she had fallen and he had not been informed. This also related to comments received from relatives that the quality of care given depended on which staff are on duty. There are generally good systems throughout the home for the administration of medications. Medicines are either administered by trained nurses or care staff who have received additional training in medicines and their safety. The majority of units do daily checks on the amount of medicines remaining, which is good practice. There were some areas of concerns noted which were brought to the managers attention. It was very pleasing to see that on the following day of the inspection he had taken action to ensure that the discrepancies identified had been addressed. Rooms that medicines were being stored on most units were generally warmer that the recommended temperature and may adversely effect medicines that are being stored there. It is acknowledged that air conditioning units were being used but The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 13 temperatures remained above safe temperatures and this needs to be addressed urgently. Staff were seen to talk to residents politely giving them respect relatives also said that ” staff are very good to residents. Some relatives did say that they thought that the home should have more male staff, although this is dependent on who applies to work at the home and there are male staff on all units. The new Simon’s assessment document also addresses privacy and dignity and makes sure that staff provide the care that people want and how they want it. This has yet to be implemented on the Working Age Dementia units (WADS) as the manager was unsure how a tool designed for the use with older adults would work with younger adults. Staff working on the Working Age Dementia are eager to implement it and feel that it could assist them also with the care and support they provide to their residents. We did see staff on the WADS unit not always treating residents with respect and dignity, such as moving them without talking to them. Others didn’t have their hair done and little attention seemed to be paid to their personal hygiene. It was positive to hear that the Home Manager has been asked to take part in the focus group with the local primary Care Trust to look at how “End of Life” care for people with dementia can be improved, this will be an excellent opportunity for the home and its residents. There was evidence to show that staff are already looking at end of life care with the use of a pre-printed care plan that looks at the spiritual, practical and religious care of people in the final stages of their life. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents preferences and chooses are being explored to ensure that daily life within the home provides suitable choice and is appropriate to the needs of the people who live there. EVIDENCE: It was positive that all units are now asking friends and relatives and when ever possible the resident to assist them in completing a “Getting to Know You” questionnaire. This questionnaire provides staff with essential information about the resident, their life, choices and interests to enable staff as much as possible to ensure that their daily life preferences can be met. The manager told us that he has recently appointed two new activities workers who are due to commence employment shortly upon clearance of all required checks. The appointment of two motivated staff, doubling the number of Activity Coordinator hours for the home will give greater opportunities for social activities and will address some of the concerns highlighted by friends and families that activities do not take place on all units despite a plan of activities that is displayed. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 15 We discussed the new Mental Capacity Act with staff discussing actions staff need to undertake when people “refuse” personal care. It is recommended that staff receive more training in this area so that they are aware of their roles in supporting people with dementia and awareness of their ability to make decisions. The majority of people living on the Working Age Dementia unit had gone to the German market on first day of inspection. The notice board on this unit also had information about events in the local community, reading club at church, bingo and al’s café. It was lovely when we visited to Aintree to see that small groups of residents and staff sitting at tables enjoying a “pot of tea” together. There were also a range of “informal” activities available on Aintree such as “rummage boxes” jigsaws and magazines. Several of the units had recently had a “Halloween party” and another unit had also just celebrated a resident’s birthday. The home does have a games room (with a snooker table) located on the ground floor which is available to be used by all residents in the home. We asked why there was restricted access by a key pad which restricts the use of the games room. Staff said that residents needed someone with them when they were in the games room. The Working Age Dementia rehabilitation Unit has a well stocked kitchen, laundry and utility room where occupational type activates takes place, as a part of the residents rehabilitation programme. It was disappointing that when visited this unit it was staff who were in the laundry doing the residents laundry and they said that residents frequently were reluctant to do their own washing meaning that this excellent facility is not appropriately used. The home also has a hairdressing salon on the ground floor with the services of a professional hairdresser, who visits two to three days per week. The salon was busy during the three days that we were in the home. The Manager said that some residents help out in the salon by cleaning; sweeping up and offering drinks to other customers. We had comments from relatives who said “the hairdresser is lovely”. The home is taking time to redecorate the units with bright colours and visually stimulating things to make it a more inviting and stimulating environment for people to live in. The Riding has been developing menus that are available to residents. The Manager stated that the home has a skilled and talented chef and kitchen staff who provide a wholesome and balance diet, appropriate to the nutritional needs and self-care feeding skills of each resident. Special dietary needs are catered for based on preference, physical needs and religious choices. We spoke to some residents and notably those with relatives on Ascot who said The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 16 that they is no choice. One relative told us that family had found that staff had given his mother curry on three occasions although he had previously said that she did not like curry. There is a list of residents’ names and their choice for each meal but it was evident that staff on Ascot had frequently identified the same choice for the all or most of the residents. Relatives on Ascot also said staff frequently put out meals leaving it to go cold before they helped to feed that resident. We did observe one person whose meal was put down in front of her for fifteen minutes before staff came to her to help her eat her meal although when they did feed her they did not rush her. Food was sampled was found to be tasty and portions were generous but again there is little in choice for vegetarians with staff still offering fish as an vegetarian option. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are required procedures in place to ensure that people are listened to and appropriate actions will be taken. EVIDENCE: The home has a robust, clear and accessible complaints procedure. The home has had four complaints since the previous inspection of which three complaints that were sent direct to the Commission for Social Care Inspection. Records of complaints seen showed that concerns had comprehensively been investigated and when required appropriate actions have been undertaken within the required timescales. The acting home manager has a weekly surgery to give residents and relatives and opportunity to discuss any issue, concern or complaint on a one to one basis. A suggestion/ compliments box is also available in the reception area of the home is people wish to comment. The home has had 17 complaints 90 responded to within 28days within the last twelve months. There have been 4 safeguarding referrals and 4 investigations of adult protection allegations. One investigation has resulted in an ex member of staff being referred to the Protection of Vulnerable Adults list as they are unsuitable to work with vulnerable adults. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 18 Staff are trained in the protection of vulnerable adults and how to apply this knowledge in their day to day practice. It was disappointing that a Unit Manager did not refer adult protection concerns timely to either CSCI or Social Services. The Manager who was on leave at the time of the incident has since taken appropriate action to ensure that staff know what actions to take when there are allegations of abuse. A Person in Charge rota is now clearly identified with the main reception area and has helped residents and visitors identify at any time who they should contact if they feel the need to formalise a concern or complaint. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is safe, well maintained and generally clean. The new décor will improve the home making it more stimulating for people with dementia. EVIDENCE: The home is making good progress in making the environment more visually stimulating for the people who live there. Ascot unit has been painted bright colours and actually looks like a rainbow when standing at the end of the unit. The manager has purchased bright wall hangings and textured rugs to promote the tactile sensation which is particularly invaluable for people with dementia. There is a games rooms on the ground floor of Aintree that everyone can access but is accessed only via a key pad. This room whilst providing some The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 20 recreation could be further developed and offer a more stimulating environment for people to use. The home remains very warm and there are still lots of portable fans around the home in an attempt to cool rooms. Champion unit looks tired and in needs of decoration, the manager is aware of this and it is on the rolling programme with some of the wall hangings to go on the walls here also. The first floor for Champion unit was relaxing, there was information available about health care needs and in particular alcohol related dementia for staff and service users. Door locks have been changed on some bedrooms as the resident was able to lock them self in although the door lock now cannot be used by the resident inside but does allow staff to lock the door potentially with the resident inside which needs to be addressed. Bedrooms that we saw as part of the case tracking process were mostly and welcoming. All of the rooms had the required equipment needed to meet service users needs. Aintree was a bit smelly during the first day of inspection but when we went back on the third day and there was no smell evident. Toilets and bathrooms although cleaned regularly need of further cleaning The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Training opportunities available are developing staff knowledge and assist in improving care that residents receive. Concern about staffing levels and gaps in the recruitment and selection of staff may mean that residents may not always get the timely care when they need it and their health and safety could be compromised. EVIDENCE: All units have rota’s displayed which show which staff are on duty at any given time. There was concern about staffing levels on some units particularly Ascot. One problem identified was that care staff do not recognise trained nurses within the care number. It was observed by Inspectors that the trained nurse on one unit did not help care staff to feed residents during a very busy and hectic lunchtime. One resident had a meal placed in front of her for fifteen minutes before anyone helped her to eat her lunch. Some relatives also confirmed their concerns about staffing levels particularly at mealtimes. One relative spoken to said that “ I would just like residents to have a meal that is hot as it is frequently just left in front of them.” The sufficiency of staff needs to be looked at further particularly as residents become increasingly dependent and reliant on staff for all their needs. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 22 There has been a significant increase in domestic and laundry staff, each floor now has a dedicated Domestic who is a part of the unit’ team. They are supported by additional 4 domestic hours per floor Monday to Friday to ensure that the cleanliness of the home increases. The new Manager has reviewed at the way that new staff are recruited and says “ we have adopted a creative approach to recruitment and selection, all staff appointed over the past 4 months have attended a recruitment and selection day, where candidates spend a day of presentations, orientation and communication exercises, all under close scrutiny of the management team. Candidates are screened and selected for interview in the afternoon. This has proved successful in appointing candidates who have the appropriate skills, aptitude and personalities needed to take on this very challenging role”. Relatives were generally positive about permanent staff although had concerns of the homes need to use agency staff. A relative said: “They are very caring and approachable at all times. My dad is always clean and seems very happy to be there” another said “The staff always listen to any worries we may have and have acted on them as soon as possible nothing is to much trouble”. Staff files were found to have some shortfalls, for example the most recent employee had a completed application form but there was only one reference and a criminal record check or a Protection of Vulnerable Adults Check first notification (POVA first) was not available. There was also a discrepancy with three other staff and it was not evident how their references related to their stated employment history. References gave the person’s name and designation for example Care Manager but as the majority of references had been sent to the referees home address it was not evident which employment they related to. There was no evidence that the manager had attempted to authenticate the references or seek the reason as to why this person left their last job, this is unsafe practice and poses a risk to residents and had also been highlighted at the previous inspection. A warning letter has been sent to the home in relation to this matter. All new staff receive a detailed induction. The manager also told us that\: “New staff are teamed with carefully selected mentors who demonstrate good care practice to ensure that the foundations for good quality care are established at the earliest opportunity”. The home has its own ongoing training plan for its workforce. There has been a considerable amount of training since the existing manager has been in post. The Ridings has at least 50 of care workers who hold a care qualification (NVQ level 2 or above). A training programme that increases staff awareness of conditions that affect the home residents such as dementia and alcohol; related dementia as well as giving them greater understanding how to manage and deescalate violence The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 23 and aggression. Staff also made positive comments about their training opportunities “We have lots of training that helps us in our role”. The home has a training matrix of all training that staff have received. It recorded that the majority of staff have attended required mandatory training with training ongoing for all staff. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager of the home provides effective leadership to ensure the smooth running of the home. Systems are in place and are being developed to monitor the service and give assurance of its ongoing improvement and ensure that people who live at the home are listened to and their health, safety and welfare is safeguarded. EVIDENCE: The home is now managed by Mr Philip Hartenfield. Mr Hartenfield is a Registered Mental Health Nurse and has extensive experience in both general management and the management of care homes for the elderly including people who have dementia. The last inspection was his first day of employment The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 25 as manager at the home, at which he expressed a determination to demonstrate that considerable improvements would be made within 6 months. This inspection found that he had achieved this. As part of the improvement plan for the home he has had to address a number of poorly performing staff which has not been popular and, as a result, discontent was expressed within some staff surveys. The home also has appointed a Deputy Manager who is also successfully addressing care practices. We had several surveys from relatives who identified improvements since the Manager and Deputy Manger have been in post: “The Ridings has improved greatly under the leadership of the new manager. The appointment of the Deputy manager has developed the care available. The care for my husband who is so ill is wonderful”. Another relative said : “Phil (Home Manager) is ok, Tracey (Deputy Manager) is ok but there are a few staff upstairs who want their ---- kicking”. There is no doubt that under the leadership of the current management team the home will continue to go forward. It is disappointing that no application has been received for Mr Hartenfield to be registered manager demonstrating his longer term commitment to the home and which would also give greater long term confidence in the home. The home has no formal quality assurance system and at present has not produced any method of gaining information from residents about the quality of the service they receive. The Manager said that he had been concentrating on improving care planning and staff training which given previous problems highlighted is understandable. A quality audit report is completed from the company’s head of clinical governance and also confirmed the substantial improvements made since the Home Manager has been in post. The implementation of a quality assurance system will also assist in the ongoing improvements of the home and give confidence that the home is run in the best interests of the residents. The Home Manager produces a bi-monthly newsletter, which is aimed at both staff and visitors to the Ridings and has been well received. He also has weekly surgeries, making himself available to residents, relatives and visitors. This is well advertised around the Home and gives people an opportunity to discuss any issue from concerns and complaints to information about dementia, medication & End of life- care. This initiative enables individuals an opportunity to be listened to in a one to one session. The home does provide a safekeeping service for residents to place their money and valuables. Accounts were found to be well maintained and reflected their current balance, where money had been spent on behalf of the resident by the home receipts were available. There are regular internal The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 26 audits of the residents account to ensure it is safely maintained. Generally ok no change in systems since the last inspection. The home has the majority of required maintenance contracts although not all could be located. The Manager highlighted that they were not available and could not be located since a departure of administration staff copies of the contracts for portable appliances testing, soiled waste contract and the gas safety certificate, will be forwarded to CSCI. Staff statutory training in areas such as fire safety, food hygiene, moving and handling, first aid and protection of vulnerable adults is much better and the deputy manager has put a new training matrix in place showing when staff training has taken place. Statutory training is ongoing for all staff giving confidence that staff will receive required and regular updates. The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 3 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 x x 2 The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19(1)(c) para 5 Schedule 2. Requirement Relevant checks must be made for all potential new employees including a reference from the most recent employer and confirmation from the NMC that a nurses registration is effective. This will help to safeguard the residents. Previous timescales of 28/02/07 and 13/7/07 not met this requirement is carried forward. Door locks must be changed to ensure that residents cannot be locked in their room and feel safe living at the home. A review of the skill and the sufficiency of staff must be undertaken. Timescale for action 23/11/07 2 OP24 23(2)(f) 31/01/08 3 OP27 18(1)(a) 15/01/08 The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP31 OP7 Good Practice Recommendations You should ensure that an application to register the new manager is made to the CSCI Central Registration Team You should have detailed care instructions or an interim care plan for new residents who are still being assessed to provide staff with information about their care needs. Medication when specified should be stored below 26oC. You should ensure that for the residents on the WAD unit there is a well-planned and practical approach to building upon existing skills and maintaining their independence. You should ensure that the activity programme on the older adult units include the choices of residents that have been gathered through an assessment process and that there is recorded evidence that it has been achieved by each resident Staff should receive training in the new mental capacity Act so that they are aware of their roles in supporting people with dementia and awareness of their ability to make decisions. You should ensure that there are improvements made to the communal areas of the home to provide residents with signs and other triggers to aid communication and recognition. You should ensure that a quality assurance system is implemented which will monitor your performance in meeting you aims and objectives, this system must include the views and opinions of the service users and their representatives. 3 4. OP9 OP14 5. OP14 6 OP14 7. OP22 8. OP33 The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Ridings DS0000067308.V354960.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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